OB quiz 3

7. The nurse administers RhoGAM to an Rh-negative client after delivery of an Rh-positive newborn based on the understanding that this drug will prevent her from: A)Becoming Rh positive B) Developing Rh sensitivity C) Developing AB antigens in her blood D)Becoming pregnant with an Rh-positive fetus

B

14.A nurse is reviewing the medical record of a postpartum client. The nurse identifies that the woman is at risk for a postpartum infection based on which of the following? (Select all that apply.) A) History of diabetes B) Labor of 12 hours C) Rupture of membranes for 16 hours D) Hemoglobin level 10 mg/dL E) Placenta requiring manual extraction

A,D,E

11.When developing the plan of care for the parents of a newborn, the nurse identifies interventions to promote bonding and attachment based on the rationale that bonding and attachment are most supported by which measure? A) Early parentinfant contact following birth B) Expert medical care for the labor and birth C) Good nutrition and prenatal care during pregnancy D) Grandparent involvement in infant care after birth

A

13.A postpartum client is experiencing subinvolution. When reviewing the woman's labor and birth history, which of the following would the nurse identify as being least significant to this condition? A) Early ambulation B) Prolonged labor C) Large fetus D) Use of anesthetics

A

13.The nurse is assisting a postpartum woman out of bed to the bathroom for a sitz bath. Which of the following would be a priority? A) Placing the call light within her reach B) Teaching her how the sitz bath works C) Telling her to use the sitz bath for 30 minutes D) Cleaning the perineum with the peri-bottle

A

20.A group of nursing students are reviewing information about maternal and paternal adaptations to the birth of a newborn. The nurse observes the parents interacting with their newborn physically and emotionally. The nurse documents this as which of the following? A) Puerperium B) Lactation C) Attachment D) Engrossment

C

20.A postpartum woman who is breast-feeding tells the nurse that she is experiencing nipple pain. Which of the following would be least appropriate for the nurse to suggest? A) Use of a mild analgesic about 1 hour before breast-feeding B) Application of expressed breast milk to the nipples C) Application of glycerin-based gel to the nipples D) Reinstruction about proper latching-on technique

A

27.A woman who delivered a healthy newborn several hours ago asks the nurse, Why am I perspiring so much? The nurse integrates knowledge that a decrease in which hormone plays a role in this occurrence? A) Estrogen B) hCG C) hPL D) Progesterone

A

3. A postpartum client has a fourth-degree perineal laceration. The nurse would expect which of the following medications to be ordered? A)Ferrous sulfate (Feosol)B) Methylergonovine (Methergine)C) Docusate (Colace)D)Bromocriptine (Parlodel)

C

4. The nurse is making a follow-up home visit to a woman who is 12 days postpartum. Which of the following would the nurse expect to find when assessing the clients fundus? A)Cannot be palpated B) 2 cm below the umbilicus C) 6 cm below the umbilicus D)10 cm below the umbilicus

A

6. Which of the following would the nurse assess as indicating positive bonding between the parents and their newborn? a. Holding the infant close to the body b. Having visitors hold the infant c. Buying expensive infant clothes d. Requesting that the nurses care for the infant

A

8. The major purpose of the first postpartum homecare visit is to: a. Identify complications that require interventions b. Obtain a blood specimen for PKU testing c. Complete the official birth certificate d. Support the new parents in their parenting roles

A

8. The nurse interprets which of the following as evidence that a client is in the taking - in phase? A) Client states, He has my eyes and nose. B) Client shows interest in caring for the newborn. C) Client performs self-care independently. D) Client confidently cares for the newborn.

A

1. A woman who is 12 hours postpartum had a pulse rate around 80 beats per minute during pregnancy. Now, the nurse finds a pulse of 60 beats per minute. Which of these actions should the nurse take? A)Document the finding, as it is a normal finding at this time. B) Contact the physician, as it indicates early DIC. C) Contact the physician, as it is a first sign of postpartum eclampsia. D)Obtain an order for a CBC, as it suggests postpartum anemia.

A

1. Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement? a. An increase in blood and lymph supply to the breasts b. An increase in estrogen and progesterone levels c. Colostrum production increases dramatically d. Fluid retention in the breasts due to the intravenous fluids given during labor

A

19.After teaching a group of students about risk factors associated with postpartum hemorrhage, the instructor determines that the teaching was successful when the students identify which of the following as a risk factor? (Select all that apply.) A) Prolonged labor B) Placenta previa C) Null parity D) Hydramnios E) Labor augmentation

B,D,E

2. When caring for a mother who has had a cesarean birth, the nurse would expect the clients lochia to be: A) Greater than after a vaginal delivery B) About the same as after a vaginal delivery C) Less than after a vaginal delivery D) Saturated with clots and mucus

C

7. Immediately after childbirth in the recovery area, the nurse observes the mother's partner's fascination and interest in the new son. This behavior is often termed: a. Attachment b. Engrossment c. Bonding d. Temperament

B

10.A nurse is working as part of a committee to establish policies to promote bonding and attachment. Which practice would be least effective in achieving this goal? A) Allowing unlimited visiting hours on maternity units B) Offering round-the-clock nursery care for all infants C) Promoting rooming-in D) Encouraging infant contact immediately after birth

B

12.A father of a newborn tells the nurse, I may not know everything about being a dad, but I'm going to do the best I can for my son. The nurse interprets this as indicating the father is in which stage of adaptation? A) Expectations B) Transition to mastery C) Reality D) Taking-in

B

14.Which of the following would lead the nurse to suspect that a postpartum woman is experiencing a problem? A) Elevated white blood cell count B) Acute decrease in hematocrit C) Increased levels of clotting factors D) Pulse rate of 60 beats/minute

B

15.A woman who gave birth 24 hours ago tells the nurse, Ive been urinating so much over the past several hours. Which response by the nurse would be most appropriate? A) You must have an infection, so let me get a urine specimen. B) Your body is undergoing many changes that cause your bladder to fill quickly. C) Your uterus is not contracting as quickly as it should. D) The anesthesia that you received is wearing off and your bladder is working again.

B

16.The nurse is assessing a postpartum clients lochia and finds that there is about a 4-inch stain on the perineal pad. The nurse documents this finding as which of the following? A) Scant B) Light C) Moderate D) Large

B

17.A nurse is making a home visit to a postpartum woman who delivered a healthy newborn 4 days ago. The woman's breasts are swollen, hard, and tender to the touch. The nurse documents this finding as which of the following? A) Involution B) Engorgement C) Mastitis D) Engrossment

B

18.A nurse is observing a postpartum client interacting with her newborn and notes that the mother is engaging with the newborn in the en face position. Which of the following would the nurse be observing? A) Mother placing the newborn next to bare breast. B) Mother making eye-to-eye contact with the newborn C) Mother gently stroking the newborns face D) Mother holding the newborn upright at the shoulder

B

19.The partner of a woman who has given birth to a healthy newborn says to the nurse, I want to be involved, but I'm not sure that I'm able to care for such a little baby. The nurse interprets this as indicating which of the following stages? A) Expectations B) Reality C) Transition to mastery D) Taking-hold

B

22.A nurse is visiting a postpartum woman who delivered a healthy newborn 5 days ago. Which of the following would the nurse expect to find? A) Bright red discharge B) Pinkish brown discharge C) Deep red mucus-like discharge D) Creamy white discharge

B

22.After teaching a postpartum woman about breast-feeding, the nurse determines that the teaching was successful when the woman states which of the following? A) I should notice a decrease in abdominal cramping during breast-feeding. B) I should wash my hands before starting to breast-feed. C) The baby can be awake or sleepy when I start to feed him. D) The babys mouth will open up once I put him to my breast.

B

23.A postpartum woman who is bottle-feeding her newborn asks the nurse, About how much should my newborn drink at each feeding? The nurse responds by saying that to feel satisfied, the newborn needs which amount at each feeding? A) 1 to 2 ounces B) 2 to 4 ounces C) 4 to 6 ounces D) 6 to 8 ounces

B

25.A postpartum woman who has experienced diastasis recti asks the nurse about what to expect related to this condition. Which response by the nurse would be most appropriate? A) Youll notice that this will fade to silvery lines. B) Exercise will help to improve the muscles. C) Expect the color to lighten somewhat. D) Youll notice that your shoe size will increase.

B

26.A group of nursing students are reviewing respiratory system adaptations that occur during the postpartum period. The students demonstrate understanding of the information when they identify which of the following as a postpartum adaptation? A) Continued shortness of breath B) Relief of rib aching C) Diaphragmatic elevation D) Decrease in respiratory rate

B

3. Which of the following suggestions would be most appropriate to include in the teaching plan for a postpartum woman who needs to lose weight? a. Increase fluid intake and acid-producing foods in her diet. b. Avoid empty-calorie foods, breastfeed, increase exercise. c. Start a high-protein, low carbohydrate diet and restrict fluids. d. Eat no snacks or carbohydrates after dinner.

B

4. The nurse would expect a postpartum woman to demonstrate lochia in which sequence? a. Rubra, alba, serosa b. Rubra, serosa, alba c. Serosa, alba, rubra d. Alba, rubra, serosa

B

4. Which statement would alert the nurse to the potential for impaired bonding between mother and newborn? A)You have your daddys eyes. B) He looks like a frog to me. C) Where did you get all that hair? D)He seems to sleep a lot.

B

5. After a normal labor and birth, a client is discharged from the hospital 12 hours later. When the community health nurse makes a home visit 2 days later, which finding would alert the nurse to the need for further intervention? A)Presence of lochia serosa B) Frequent scant voidings C) Fundus firm, below umbilicus D)Milk filling in both breasts

B

7. A postpartum client who is bottle feeding her newborn asks, When should my period return? Which response by the nurse would be most appropriate? A)Its difficult to say, but it will probably return in about 2 to 3 weeks. B) It varies, but you can estimate it returning in about 7 to 9 weeks. C) You won't have to worry about it returning for at least 3 months. D)You don't have to worry about that now. It'll be quite a while.

B

9. The nurse is instructing the postpartum client who plans to bottle-feed her newborn about measures to prevent breast engorgement when she is discharged. Which of the following measures should the nurse include in the teaching plan? a. Decreasing her fluid intake for the first week at home b. Wearing a tight-fitting supportive bra 24 hours daily c. Take a diuretic to release the extra fluid in the breasts d. Manually express the milk that is accumulating

B

Which of the following would the nurse interpret as being least indicative of paternal engrossment? A) Demonstrating pleasure when touching or holding the newborn B) Identifying imperfections in the newborns appearance C) Being able to distinguish his newborn from others in the nursery D) Showing feelings of pride with the birth of the newborn

B

24.A nursing student is preparing a class presentation about changes in the various body systems during the postpartum period and their effects. Which of the following would the student include as influencing a postpartum woman's ability to void? (Select all that apply.) A) Use of an opioid anesthetic during labor B) Generalized swelling of the perineum C) Decreased bladder tone from regional anesthesia D) Use of oxytocin to augment labor E) Need for an episiotomy

B,C,D

21.A nurse is developing a teaching plan for a postpartum woman who is breast-feeding about sexuality and contraception. Which of the following would the nurse most likely include? (Select all that apply.) A) Resumption of sexual intercourse about two weeks after delivery B) Possible experience of fluctuations in sexual interest C) Use of a water-based lubricant to ease vaginal discomfort D) Use of combined hormonal contraceptives for the first three weeks E) Possibility of increased breast sensitivity during sexual activity

B,C,E

24.A nurse is observing a postpartum woman and her partner interact with the their newborn. The nurse determines that the parents are developing parental attachment with their newborn when they demonstrate which of the following? (Select all that apply.) A) Frequently ask for the newborn to be taken from the room B) Identify common features between themselves and the newborn C) Refer to the newborn as having a monkey-face D) Make direct eye contact with the newborn E) Refrain from checking out the newborns features

B,D

1. A primipara client gave birth vaginally to a healthy newborn girl 48 hours ago. The nurse palpates the clients fundus, expecting it to be at which location? A)Two finger-breadths above the umbilicus B) At the level of the umbilicus C) Two finger-breadths below the umbilicus D)Four finger-breadths below the umbilicus

C

1. When assessing a postpartum woman, which of the following would lead the nurse to suspect postpartum blues? a. Panic attacks and suicidal thoughts b. Anger toward self and infant c. Periodic crying and insomnia d. Obsessive thoughts and hallucinations

C

11.The nurse develops a teaching plan for a postpartum client and includes teaching about how to perform Kegel exercises. The nurse includes this information for which reason? A) Reduce lochia B) Promote uterine involution C) Improve pelvic floor tone D) Alleviate perineal pain

C

12.A postpartum woman is having difficulty voiding for the first time after giving birth. Which of the following would be least effective in helping to stimulate voiding? A) Pouring warm water over her perineal area B) Having her hear the sound of water running nearby C) Placing her hand in a basin of cool water D) Standing her in the shower with the warm water on

C

15.A nurse is completing a postpartum assessment. Which finding would alert the nurse to a potential problem? A) Lochia rubra with a fleshy odor B) Respiratory rate of 16 breaths per minute C) Temperature of 101 F D) Pain rating of 2 on a scale from 0 to 10

C

17.When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which of the following? A) Superficial structures above the muscle B) Through the perineal muscles C) Through the anal sphincter muscle D) Through the anterior rectal wall

C

18.A nurse is assessing a postpartum woman's adjustment to her maternal role. Which of the following would the nurse expect to occur first? A) Reestablishing relationships with others B) Demonstrating increasing confidence in care of the newborn C) Assuming a passive role in meeting her own needs D) Becoming preoccupied with the present

C

2. In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman's behavior to be characterized as which of the following? a. Gaining self-confidence b. Adjusting to her new relationships c. Being passive and dependent d. Resuming control over her life

C

2. To decrease the pain associated with an episiotomy immediately after birth, which action by the nurse would be most appropriate? A)Offer warm blankets. B) Encourage the woman to void. C) Apply an ice pack to the site. D)Offer a warm sitz bath.

C

4. After teaching a group of breast-feeding women about nutritional needs, the nurse determines that the teaching was successful when the women state that they need to increase their intake of which nutrients? a. Carbohydrates and fiber b. Fats and vitamins c. Calories and protein d. Iron-rich foods and minerals

C

5. The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected? a. Cream-colored lochia; uterus above the umbilicus b. Bright-red lochia with clots; uterus 2 fingerbreadths below umbilicus c. Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus d. Yellow, mucousy lochia; uterus at the level of the umbilicus

C

6. A primipara client who is bottle feeding her baby begins to experience breast engorgement on her third postpartum day. Which instruction would be most appropriate to aid in relieving her discomfort? A)Express some milk from your breasts every so often to relieve the distention. B) Remove your bra to relieve the pressure on your sensitive nipples and breasts. C) Apply ice packs to your breasts to reduce the amount of milk being produced. D)Take several warm showers daily to stimulate the milk let-down reflex.

C

6. When the nurse is assessing a postpartum client approximately 6 hours after delivery, which finding would warrant further investigation? A)Deep red, fleshy-smelling lochia B)Voiding of 350 cc C) Heart rate of 120 beats/minute D)Profuse sweating

C

7. Which activity would the nurse include in the teaching plan for parents with a newborn and an older child to reduce sibling rivalry when the newborn is brought home? a. Punishing the older child for bedwetting behavior b. Sending the sibling to the grandparents' house c. Planning a daily "special time" for the older sibling d. Allowing the sibling to share a room with the infant

C

8. Which of the following factors in a clients history would alert the nurse to an increased risk for postpartum hemorrhage? A)Multiparity, age of mother, operative delivery B) Size of placenta, small baby, operative delivery C) Uterine atony, placenta previa, operative procedures D)Prematurity, infection, length of labor

C

9. After teaching parents about their newborn, the nurse determines that the teaching was successful when they identify the development of a close emotional attraction to a newborn by parents during the first 30 to 60 minutes after birth as which of the following? A) Reciprocity B) Engrossment C) Bonding D) Attachment

C

The nurse is aware the complication of most concern with the highest priority for assessment in the first hour is what? a) Dehydration b) Bladder distention c) Hemorrhage d) Infection

C

6. Prioritize the postpartum mother's needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need. a. _________ Learn how to hold and cuddle the infant. b. _________Watch a baby bath demonstration given by the nurse. c. _________ Sleep and rest without being disturbed for a few hours. d. _________ Interaction time (first 30 minutes) with the infant to facilitate bonding.

D,C,A,B

10. A new mother was brought to the postpartum unit who gave birth 12 hours ago. Because this is her first child, which of the following goals by the nurse is most appropriate? a. Early discharge for the mother and newborn b. Rapid transition into her role of being a parent/caretaker c. Minimal need for expression of her feelings now d. Effective education of both parents before discharge

D

10.A postpartum client comes to the clinic for her 6-week postpartum checkup. When assessing the clients cervix, the nurse would expect the external cervical os to appear: A) Shapeless B) Circular C) Triangular D) Slit-like

D

16.A group of students are reviewing the process of breast milk production. The students demonstrate understanding when they identify which hormone as responsible for milk let-down? A) Prolactin B) Estrogen C) Progesterone D) Oxytocin

D

2. Which of these activities would best help the postpartum nurse to provide culturally sensitive care for the childbearing family? a. Taking a transcultural course b. Caring for only families of his or her cultural origin c. Teaching Western beliefs to culturally diverse families d. Educating himself or herself about diverse cultural practices

D

21.After teaching a group of nursing students about the process of involution, the instructor determines that additional teaching is needed when the students identify which of the following as being involved? A) Catabolism B) Muscle fiber contraction C) Epithelial regeneration D) Vasodilation

D

23.A nurse teaches a postpartum woman about her risk for thromboembolism. Which of the following would the nurse be least likely to include as a factor increasing her risk? A) Increased clotting factors B) Vessel damage C) Immobility D) Increased red blood cell production

D

3. The nurse is developing a teaching plan for a client who has decided to bottle feed her newborn. Which of the following would the nurse include in the teaching plan to facilitate suppression of lactation? A)Encouraging the woman to manually express milk B) Suggesting that she take frequent warm showers to soothe her breasts C) Telling her to limit the amount of fluids that she drinks D)Instructing her to apply ice packs to both breasts every other hour

D

3. The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the after-pains she is experiencing can be the result of which of the following? a. Abdominal cramping is a sign of endometriosis b. A small infant weighing less than 8 lb c. Pregnancies that were too closely spaced d. Contractions of the uterus after birth

D

5. A client who is breast-feeding her newborn tells the nurse, I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now? Which response by the nurse would be most appropriate? A)Your uterus is still shrinking in size; thats why youre feeling this pain. B) Let me check your vaginal discharge just to make sure everything is fine. C) Your body is responding to the events of labor, just like after a tough workout. D)The babys sucking releases a hormone that causes the uterus to contract.

D

5. Which of the following would lead the nurse to suspect that a postpartum woman was developing a complication? a. Fatigue and irritability b. Perineal discomfort and pink discharge c. Pulse rate of 60 bpm d. Swollen, tender, hot area on breast

D

8. After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will a. "Need to take medication daily to treat the anxiety and sadness." b. "Call the OB support line only if I start to hear voices." c. "Contact my doctor if I become dizzy and fell nauseated." d. "Feel like laughing one minute and crying the next minute."

D

Which lochia pattern should be reported immediately? a) Lochia progresses from rubra to serosa to alba within 10 days b) Moderate flow of lochia rubra on day 3 postpartum, changing to serosa on day 5 c) Moderate lochia rubra on day 3, mixed serosa and rubra on day 4, light serosa on day 5 d) Moderate lochia serosa on day 4 postpartum, increasing in volume and changing to rubra on day 5

D

Which reason explains why women should be encouraged to perform Kegel exercises after delivery? a) They assist the woman in burning calories for rapid postpartum weight loss. b) They promote the return of normal bowel function. c) They assist with lochia removal. d) They promote blood flow, enabling healing and muscle strengthening.

D

25.After reviewing information about postpartum blues, a group of students demonstrate understanding when they state which of the following about this condition? A) Postpartum blues is a long-term emotional disturbance. B) Sleep usually helps to resolve the blues. C) The mother loses contact with reality. D) Extended psychotherapy is needed for treatment.

b